Acute Effects of 30 g Cyclodextrin Intake during CrossFit® Training on Performance and Fatigue.

The main objective of this study was to investigate the influence of carbohydrate intake (cyclodextrin) on performance during the performance of two consecutive workouts of the day (WODs) lasting 20 min each. Twenty-one male CrossFit (CF) athletes (29.5 ± 4.3 years; 72.81 ± 12.85 kg; 1.74 ± 0.06 m; 3.41 ± 1.21 years of experiences) participated in a crossover, randomized, and double-blind study. The effect of supplementation with 30 g of cyclodextrin (SG) (Cluster Dextrin®) or placebo (PG) (Bolero Advanced Hydration®) was evaluated on the performance of two specific WOD. Additionally, the effect on handgrip maximum strength, countermovement jump (CMJ), Wingate test, and 1 RM bench press test was evaluated. The effect on blood glucose and lactate was also evaluated. No differences were found in time, height, and power (W/Kg) in CMJ. However, there was a percentage improvement in CMJ jump power (W) (p < 0.05) between the groups, assuming an improvement in performance due to the intervention. Moreover, both conditions experimented differences in execution speed between sets (p < 0.05) in pre-WOD, and differences in post-WOD only in the placebo group, as well as decreases in this variable per repetition across the set (p < 0.01) in both conditions. However, no differences were found in the rest of the variables. Supplementation with 30 g of cyclodextrin did not have any metabolic or performance effects in CF tests. Although some differences between groups were observed in CMJ and power tests for bench press, the data are not conclusive and further research is needed in this regard.

Ecospirituality and Health: A Systematic Review.

Environmental changes are affecting human health. A renewal of the way we understand and relate to the planet is needed. Ecospirituality brings together the terms spirituality and environment and is born as a means of solution to this dilemma. This systematic review aimed to find out the influence of ecospirituality on global health. A search of scientific literature was carried out in the main health science databases. A review was conducted to critically evaluate the studies that identified relevant ecospiritual aspects regarding health care for communities. After a systematic search and screening, and following specified methodological criteria, a total of 14 articles were selected in the review. The findings of the review suggest that a new perspective in our worldview such as ecospirituality will provide us with the necessary keys to improve health. To understand ecospirituality, we must keep in mind the indigenous way of life, which is the clear example to follow to achieve environmental health and global health. Ecospirituality leads to a healthier environment, and as this is directly related to health, there is also an improvement in global health.

Malestar psicológico y preocupaciones psicosociales durante la tercera ola de la pandemia en pacientes oncológicos y familiares: Un análisis exploratorio / Distress and pychosocial concers during the third wave of the pandemic among oncological patients and family caregivers: an exploratory análisis

Objetivo: Describir el malestar psicológico y las preocupaciones psicosociales durante la tercera ola de la pandemia de los pacientes oncológicos y sus familiares y analizar la evolución de estas variables teniendo como referencia los meses de abril y diciembre de 2020. Método. Se utilizó un cuestionario autoadministrado que estaba compuesto por ítems elaborados ad hoc para evaluar las características sociodemográficas y las preocupaciones psicosociales y la escala Kessler K-6 para evaluar el malestar psicológico. Resultados. La proporción de pacientes y familiares que presentaban niveles clínicos de malestar era mayor que la de la población general. El porcentaje de personas con cáncer que mostraba malestar psicológico en niveles clínicos se incrementó significativamente durante el mes de diciembre de 2020, en comparación con el mes de abril. Este aumento fue especialmente significativo entre las mujeres y los pacientes más jóvenes, siendo también estas poblaciones las más afectadas en el primer momento de medida. Las preocupaciones más frecuentes en la población oncológica (pacientes y familiares) durante el mes de diciembre de 2020 fueron: el miedo a contraer la COVID-19, la inquietud y el miedo al futuro, la suspensión de los contactos y la ausencia del contacto cara a cara y la inactividad en las calles y comercios. Conclusiones. Los resultados de este estudio destacan la necesidad de desarrollar intervenciones específicas que permitan cubrir las secuelas psicológicas y las preocupaciones psicosociales derivadas de la COVID-19 en los pacientes oncológicos y sus familiares (AU)

Aim: Describe the psychological distress and the psychosocial concerns during the third wave of the pandemic in oncological patients and family caregivers and analyze the evolution of these variables in cancer patients taking as references April and December of 2020. Method. The researchers developed a self-administered questionnaire. It was composed by items developed ad hoc to assess sociodemographic characteristics and social concerns and the Kessler K-6 scale to measure psychological distress. Results.The proportion of oncological patients and family caregivers who showed clinical levels of distress was higher than that the ones of non-oncological population during December 2020. Clinical distress was higher in oncological patients during the December 2020, compared to April levels. This increase was especially significant among women and younger patients in both assessment moments. The main social concerns at the third wave for oncological patients and family caregivers were: the fear of contracting COVID-19, restlessness and fear of the future, suspension of the social contacts, the absence of face-to-face contact and inactivity in the streets and shops. Conclusions.The results of this study highlight the need to provide the proper care to oncological patients and family caregivers due to the presence of socio-emotional needs, and to develop strategies that allow them to be covered from psychological impact of COVID-19 (AU)

Does immediate skin-to-skin contact at caesarean sections promote uterine contraction and recovery of the maternal blood haemoglobin levels? A randomized clinical trial.

AIM: We analysed whether immediate skin-to-skin contact between the healthy newborn and the mother after a caesarean section has a modulatory role on postpartum haemorrhage and uterine contraction. DESIGN: Unblinded, randomized clinical trial, simple random sampling, conducted in women undergoing caesarean sections. METHODS: Of the population identified, the caesarean section total (N = 359), 23.2% (N = 83) met the inclusion criteria: scheduled caesarean section, accepting skin-to-skin contact, good level of consciousness. They were randomly allocated to the intervention group, skin-to-skin contact (N = 40), and to the control group, usual procedure (N = 40). There were three losses. Clinical variables: plasma haemoglobin, uterine contraction, breastfeeding, postoperative pain, were measured, and subjective variables: maternal satisfaction, comfort, comparison with previous caesarean section and newborn crying. RESULTS: Women with skin-to-skin contact had greater uterine contraction after caesarean section. The maternal plasma haemoglobin levels at discharge were significantly higher. It was associated with higher breastfeeding rate, satisfaction, comfort levels and with less maternal pain and less crying in the newborn.

Concordancia de información paciente-cuidador en cáncer avanzado / Concordance of patient-caregiver information in advanced cancer

Introducción: la presencia de una enfermedad avanzada con frecuencia es una de las situaciones que provoca una mayor crisis de estabilidad familiar y conduce a una mayor interacción entre los miembros de la familia. En ocasiones el progreso de la enfermedad provoca un alto deterioro del paciente, dificultando la autonomía y condicionando tomar sus propias decisiones. En esta situación el papel del cuidador es clave en el proceso de toma de decisiones relativas al plan de cuidados del paciente, respetando sus preferencias y deseos. Lo que sugiere que la apropiada comunicación y concordancia sobre la información de la enfermedad sea prioritario. Objetivo: valorar la concordancia de la información que tienen los pacientes con cáncer avanzado y su cuidador principal, atendidos por un equipo de soporte hospitalario (ESH) de cuidados paliativos y determinar las variables que se asocian a la concordancia. Método: fueron incluidos 52 diadas paciente-cuidador atendidos por el Equipo de Soporte Hospitalario de Cuidados Paliativos del Hospital Universitario de Getafe. Se recogieron mediante una entrevista las variables de información, sociodemográficas y psicoafectivas del paciente y cuidador principal. Resultados: La concordancia de la información entre el paciente y su cuidador principal fue del 78,8% sobre el diagnóstico y la gravedad; del 43,5% acerca de la curación; del 48,0% sobre el objetivo del tratamiento, y un 43,7% del final de vida; siendo la concordancia de un 71,4% en no conocer ni paciente ni cuidador el final de vida. Conclusiones: Existe un déficit de información y escasa concordancia entre el paciente y su cuidador principal. Es necesario aplicar protocolos que faciliten a los profesionales la comunicación. La herramienta utilizada para evaluar el nivel de información permite valorar de forma específica, sencilla... (AU)

Introduction: The presence of an advanced cancer is usually one of the situations that causes a greater crisis of family stability and leads to greater interaction between family members. Sometimes the progression of the disease causes a high deterioration of the patient, puts their autonomy at risk and conditions their own decision-making. In this situation, the role of the caregiver is key in the decision-making process about the patient’s care plan, respecting their preferences and wishes, therefore adequate communication and concordance about the information on the disease is a priority. Objective: to assess the concordance of the information that patients with advanced cancer and their main caregiver have, attended by a hospital support team for palliative care, and to determine the variables that are associated with concordance. Method: 52 patient-caregiver dyads attended by the Palliative Care Hospital Support Team of the University Hospital of Getafe were included. The information, sociodemographic and psychoaffective variables of the patient and main caregiver were collected through an interview. Results: The concordance of the information between the patient and his main caregiver was 78.8% on the diagnosis and severity; 43.5% about healing; 48.0% over the treatment objective, and 43.7% at the end of life; being the concordance of 71.4% in not knowing neither patient nor caregiver at the end of life. Conclusions: There is a lack of information and little concordance between the patient and their primary caregivers. It is necessary to apply protocols that facilitate communication for professionals. The tool used to assess the level of information allows (AU)

Los deseos de información en pacientes con cáncer avanzado / The desire for information in patients with advanced cancer

Objetivo: Comprobar los deseos de información, y las variables asociadas a ello, en los pacientes con cáncer avanzado atendidos por un Equipo de Soporte Hospitalario de Cuidados Paliativos. Método: Noventa pacientes con cáncer avanzado, fueron evaluados, mediante una entrevista estructurada sobre si tenían información sobre su enfermedad de los siguientes tipos: diagnóstico, curación, gravedad, objetivos del tratamiento y final de vida, y de su deseo de tener información en cada uno de esto cinco tipos de información. Además, se recogieron los datos sociodemográficos y clínicos, y se administraron: la Escala de Capacidad Funcional, el Índice de Comorbilidad de Charlson, y la Escala de Ansiedad y Depresión Hospitalaria. Resultados. Los resultados muestraron que la mayoría de los pacientes estaban informados del diagnóstico, y de la gravedad, pero no de los objetivos de tratamiento, la curación y el final de vida. De los pacientes no informados el 77,8% (14) deseaban conocer el diagnostico, el 60,0% (11) la gravedad, el 77,8% (35) el objetivo del tratamiento, el 76,7% (24) la curación y un 34,4% (10) el final de vida. Las variables asociadas al deseo de: a) información diagnóstica fueron: tener un cuidador principal más joven (p=,023); con pareja (p=,018), no religiosos (p=,025) y mayor número de visitas a urgencias (p=,004); b) información sobre gravedad fueron: ser joven (p=,009); con pareja (p=,04), y mejor estado ánimo (p=,009); c). Información sobre objetivos del tratamiento: ser joven (p=,001), Con pareja (p=,04), mejor estado ánimo (p=,001). d) información sobre curación: ser hombre (p=,018), con pareja (p=,04), no religiosos (p=,023). En el caso de información sobre el tiempo de vida no se encontró ninguna diferencia significativa

Objective: to study the desire for information in patients with avanzado cancer, and the variables associated with it. Method: Ninety patients with avanzado cancer were evaluated through a structured interview about the information of their disease of the following types: Diagnosis, cure, severity, goal of treatment and time for the end of life, and their desire to have information about each of these five types of information. In addition, sociodemographic and clinical data were collected and administered: the Functional Capacity Scale, the Charlson Comorbidity Index and the Hospital Anxiety and Depression Scale. Results. The results showed that most patients are informed about the diagnosis and its severity, but scarcely about the goals of treatment, cure and end-of-life. Of the uninformed patients, 77.8% (14) wanted to know the diagnosis, 60.0% (11) the severity, 77.8% (35) the treatment goal, 76.7% (24 ) healing and 34.4% (10) end-of-life. The variables associated with the desire for: a) diagnostic information were: having a younger primary caregiver (p=.023); with a partner (p=.018), non-religious (p=.025) and a greater number of visits to the emergency room (p=.004); b) severity information were: being young (p=.009); with a partner (p=.04), and low depression (p=.009); C). Information about the goals of treatment: being young (p=.001), being in a relationship (p=.04), and low depression (p=.001). d) information about healing: being a man (p=.018), with a partner (p=.04), not religious (p=.023). In the case of lifetime information, no significant difference was found. Conclusions: it is necessary to evaluate the information and desires that patients have about the different types of information, so the creation of a standardized tool in future research is a priority

Psychosocial impact of the COVID-19 outbreak and lockdown on Spanish oncological patients: a quantitative approach.

BACKGROUND: This study analyses the levels of distress and related psychosocial factors among cancer patients during the Spanish lockdown due to COVID-19. METHODS: A total of 2,779 cancer patients took part in an observational and lateral study carried out between April 16, 2020 and April 25, 2020. An online questionnaire was distributed including distress-related variables, demographic variables, clinical variables about their oncological condition, socioeconomic variables and variables related to information management and social communication. Distress was measured according to the Kessler (K-6) scale, and its relationship with the remaining variables was analyzed by logistic regression. RESULTS: 33.5% of the patients yielded levels of clinical distress during lockdown. Younger patients and women yielded significantly higher levels of distress. High distress levels were generally associated with the following factors: trust in medical institutions; deterioration of the household's financial conditions; and media management of the information about the pandemic. CONCLUSIONS: The lockdown triggered by COVID-19 increased distress among cancer patients, and this can be significantly related to a number of variables. Identifying distress, and said factors, at an early stage can help to develop mitigation strategies. Similarly, early detection can help to improve the way information is shared with patients, offer them support and resources and direct them to psychosocial services, increasing the patient's ability to return to normal after COVID-19.

Factores relacionados con el proceso de información en pacientes con cáncer avanzado / Factors related to the information process in patients with advanced cancer

OBJETIVO: Nuestro objetivo fue determinar el grado de conocimiento de su enfermedad que tienen los pacientes con cáncer avanzado atendidos por un Equipo de Soporte Paliativo Hospitalario (ESPH) en un hospital terciario y los factores relacionados con el grado de conocimiento. MÉTODO: Se realizó un estudio observacional prospectivo con una cohorte de pacientes valorados por un ESPH que cumplían los siguientes criterios de inclusión: mayor de 18 años, buena comprensión y expresión del castellano, PPS = 30, ausencia de deterioro cognitivo que impidiera la adecuada realización de las entrevistas y fi rma el consentimiento informado. Se realizó una entrevista semiestructurada y se recogieron datos clínicos y asistenciales de la historia clínica. Se desarrolló una escala con el objetivo de evaluar el grado de conocimiento sobre el proceso de enfermedad del paciente en situación de enfermedad oncológica avanzada. La puntuación podía variar entre 0 y 4, asignando el valor de 1 o 0 al conocimiento sobre los diferentes aspectos de la enfermedad. Se realizó una estadística descriptiva básica expresándose los datos de las variables cuantitativas como media (desviación estándar) y mediana (rango intercuartílico) y los datos de las variables cualitativas como proporción. Para estudiar la asociación de variables cualitativas se utilizó el test de Chi-cuadrado o el test exacto de Fisher y para la comparación de medias de grupos independientes, el test de U de Mann Whitney. Para el análisis de estos datos se utilizó la versión 15 del programa SPSS. RESULTADOS: Se realizaron 50 entrevistas. El 82 % de los pacientes estaba informado correctamente del diagnóstico de la enfermedad que padecían y el 76 % sabía que era una enfermedad grave, aunque el 47 % conocía que el objetivo del tratamiento no era la curación y solo el 39 % que no se podían curar. En el análisis de la relación de los factores estudiados con el grado de conocimiento del proceso de enfermedad, se encontraron diferencias clínicamente relevantes (diferencias de = 0,8 puntos en la escala) y estadísticamente significativas respecto al nivel de estudios (bajo: 2,1 ± 1,3 vs. alto: 3,3 ± 0,9; p = 0,03) y al número de visitas a urgencias en los 6 meses previos (= 2 visitas 1,9 ± 1,2 vs. > 2 visitas 2,8 ± 1,3; p = 0,02). CONCLUSIONES: En esta cohorte de pacientes hay un escaso conocimiento del pronóstico de la enfermedad y, por lo tanto, resulta difícil que puedan participar en decisiones importantes sobre el final de su vida. Aunque estos datos no son extrapolables, sí sugieren la necesidad de un mayor esfuerzo por parte de los profesionales en valorar la necesidad de información de los pacientes sobre su proceso de enfermedad. Por otro lado, el estudio pone de manifiesto la necesidad de desarrollar una herramienta que permita estandarizar la valoración y el registro del grado de conocimiento sobre el proceso de enfermedad. Se propone una escala de grado de conocimiento del proceso de enfermedad que podría permitir valorar el conocimiento sobre diagnóstico, gravedad, objetivo de tratamiento y conciencia de final de vida. Se precisan futuros estudios que permitan valorar su utilidad en la práctica clínica y en la realización de estudios sobre información

OBJECTIVE: Our goal was to determine the degree of knowledge advanced cancer patients have about their condition while being cared for by a Hospital Palliative Care Team (HPCT) in a tertiary referral hospital, and the factors associated therewith. METHODS: A prospective observational study was carried out in a cohort of patients cared for by an HPCT. All of them complied with the following inclusion criteria: over 18 years of age, good understanding and use of the Spanish language, PPS = 30, absence of cognitive impairment that could potentially hamper the interviewing process, and signing of an informed consent form. A semi-structured interview was performed during which medical history data were obtained. A scale was developed to assess degree of knowledge about their disease in patients with advanced cancer. Scores ranged from 0 to 4, with 1 or 0 being assigned to different aspects of the condition involved. Basic descriptive statistics were used to express quantitative variables as mean (standard deviation) and median (interquartile range) values, and qualitative variables as proportions. In order to study the association of qualitative variables the Chi-squared or Fisher's exact tests were used; the Mann-Whitney U-test was used to compare mean values for independent groups. The analysis was performed using the SPSS V.15 package. RESULTS: Fifty interviews were performed; 82% of subjects were correctly informed about their illness, and 76% knew it was a serious disease, although only 47% of patients knew that the goal of their treatment was not total recovery, and only 39% were aware that they could not be cured. After analyzing the relationship between the factors under study and the degree of knowledge about the course of disease, clinically relevant differences were found (differences = 0.8 points within the scale), which were statistically significant with respect to educational background (low: 2.1 ± 1.3 vs. high: 3.3 ± 0.9; p = 0.03) and number of visits to the emergency room over the previous six months (= 2 visits, 1.9 ± 1.2 vs > 2 visits, 2.8 ± 1.3; p = 0.02). CONCLUSIONS: In this cohort of patients knowledge was poor about disease prognosis; consequently, patients could hardly take part in the important decisions required about the end of their lives. Although these data may not be extrapolated, they do suggest the need for greater efforts by professionals in assessing the need for information patients have about their disease. Also, the study highlights the need for developing a tool to help standardize the process of assessing and recording degree of disease knowledge. A disease knowledge scale is proposed to assess knowledge regarding diagnosis, severity, treatment goals, and end-of-life awareness. Further studies are needed to evaluate its usefulness for clinical practice, and to help carry out informative studies

Effect of tunable redox behavior of bis chelate substituted 1,10-phenantroline Cu(II) complexes on its reaction with superoxide anion in DMSO. Toward a simple criterion to identify a SOD-like mechanism.

In this work we report a series of Cu(II) complexes [Cu(N-N)2(X)]+, (N-N=substituted 1,10-phenanthroline derivatives and X=Cl- or NO3-), with tunable E1/2 for electrochemical reduction [CuII(N-N)2(X)]++1e-⇌[CuI(N-N)2]+X-. The disproportion of O2•- was explored in presence of the electro-generated species [CuI(N-N)2]+ using cyclic voltammetry in a non-aqueous media, arising a new simple method to propose a SOD-like mechanism, which can be used as a quick guide test for a compound, before being proven in biological assays. It was found that complexes with high negative half wave potential values (E1/2) for Cu(II)/Cu(I) couple shown a current increment for oxygen reduction, related to the capability of the disproportion of this reactive oxygen species.

Información sobre la quimioterapia paliativa en pacientes con cáncer avanzado: una revisión / Information on palliative chemotherapy in patients with advanced cancer: a review

Introducción. La quimioterapia paliativa es el tratamiento específico de primera elección en la mayoría de los pacientes oncológicos con enfermedad avanzada y es esencial que los pacientes entiendan los objetivos del tratamiento y las expectativas se ajusten al proceso de la enfermedad. Objetivo: Hacer una revisión sistemática sobre las creencias y expectativas que tienen los pacientes que reciben quimioterapia paliativa. Método. Se realizaron búsquedas en PubMed desde el año 2000 hasta la actualidad. Artículos escritos en inglés y español. Un total de 20 artículos cumplieron los criterios de inclusión. Resultados: Alrededor de la mitad de los pacientes que reciben quimioterapia paliativa, tienen creencias erróneas sobre las expectativas y objetivos del tratamiento. Los pacientes que entienden los objetivos del tratamiento presentan menor probabilidad de recibir quimioterapia al final de la vida, menores síntomas de ansiedad y depresión, mayor sensación de control y deseo de cuidados paliativos que se asocian a mejor calidad de vida. Conclusión: un porcentaje significativo de pacientes oncológicos en fase avanzada, reciben quimioterapia paliativa sin conocer el objetivo del tratamiento con expectativas erróneas de curarse, lo que dificulta la participación en la toma de decisiones sobre su plan de cuidados

Introduction: Palliative chemotherapy is the first-line specific treatment in most oncology patients with advanced disease and it is essential for patients to understand the goals of treatment and expectations to fit the disease process. Objective: To systematically review the beliefs and expectations of patients receiving palliative chemotherapy about treatment. Method: We searched PubMed from 2000 to the present. Articles written in English and Spanish. A total of 20 articles met the inclusion criteria. Results: About half of patients receiving palliative chemotherapy have misconceptions about treatment expectations and goals. Patients who understand the goals of treatment are less likely to receive chemotherapy at the end of life, less anxiety and depression, greater sense of control and desire for palliative care associated with better quality of life

Underwater Communications for Video Surveillance Systems at 2.4 GHz.

Video surveillance is needed to control many activities performed in underwater environments. The use of wired media can be a problem since the material specially designed for underwater environments is very expensive. In order to transmit the images and videos wirelessly under water, three main technologies can be used: acoustic waves, which do not provide high bandwidth, optical signals, although the effect of light dispersion in water severely penalizes the transmitted signals and therefore, despite offering high transfer rates, the maximum distance is very small, and electromagnetic (EM) waves, which can provide enough bandwidth for video delivery. In the cases where the distance between transmitter and receiver is short, the use of EM waves would be an interesting option since they provide high enough data transfer rates to transmit videos with high resolution. This paper presents a practical study of the behavior of EM waves at 2.4 GHz in freshwater underwater environments. First, we discuss the minimum requirements of a network to allow video delivery. From these results, we measure the maximum distance between nodes and the round trip time (RTT) value depending on several parameters such as data transfer rate, signal modulations, working frequency, and water temperature. The results are statistically analyzed to determine their relation. Finally, the EM waves' behavior is modeled by a set of equations. The results show that there are some combinations of working frequency, modulation, transfer rate and temperature that offer better results than others. Our work shows that short communication distances with high data transfer rates is feasible.

Cumplimiento de indicadores de proceso en personas con diabetes tipo 2 y la vinculación a incentivos en Atención Primaria / Compliance with process indicators in people with type 2 diabetes and linking incentives in Primary Care

OBJETIVO: Los programas de pago por desempeño para mejorar la calidad de la atención sanitaria se están extendiendo de forma progresiva, en particular para en Atención Primaria. Nuestro objetivo fue explorar la relación entre el grado de cumplimiento de los indicadores de proceso (IPr) de la diabetes mellitus tipo 2 (DM2) en Atención Primaria y la vinculación a incentivos económicos. DISEÑO: Estudio descriptivo observacional, descriptivo y transversal. Emplazamiento: Seis centros de salud del Distrito Aljarafe, Sevilla, seleccionados de forma aleatoria y estratificada por tamaño poblacional. PARTICIPANTES: De un total de 3.647 sujetos incluidos en el Proceso Asistencial Integrado de DM2 durante el 2008, se incluyó a 366 pacientes, según cálculo de tamaño muestral, mediante muestreo aleatorio estratificado. Mediciones: IPr: exploración de fondo de ojo y pies, hemoglobina glucosilada (HbA1c), perfil lipídico, microalbuminuria y electrocardiograma. Variables potencialmente confusoras: edad, género, característica de zona de residencia en pacientes y variables de los médicos. RESULTADOS: La edad media fue de 66,36 (desviación estándar -DE- 11,56 años); el 48,9% eran mujeres. Los IPr con mejor cumplimiento fueron la exploración de pies, HbA1c y perfil lipídico (59,6, 44,3 y 44, respectivamente). El 2,7% de los pacientes presentaban cumplimiento simultáneo de los 6 IPr y el 11,74% de los 3 IPr vinculados a incentivos. El cumplimiento de IPr vinculado y no a incentivos mostró asociación significativa (p = 0,001). CONCLUSIONES: El cumplimiento de los IPr para el cribado de complicaciones crónicas de la DM2 es en su mayoría bajo, aunque este fue superior en los indicadores vinculados a incentivos

OBJECTIVE: Pay-for-performance programs to improve the quality of health care are extending gradually, particularly en Primary Health Care. Our aim was to explore the relationship between the degree of compliance with the process indicators (PrI) of type 2 diabetes (T2DM) in Primary Care and linkage to incentives. DESIGN: Cross-sectional, descriptive, observational study. SETTING: Six Primary Health Care centers in Seville Aljarafe District randomly selected and stratified by population size. PARTICIPANTS: From 3.647 adults included in Integrated Healthcare Process of T2DM during 2008, 366 patients were included according sample size calculation by stratified random sampling. Measurements: PrI: eye and feet examination, glycated hemoglobin, lipid profile, microalbuminuria and electrocardiogram. Confounding: Age, gender, characteristics town for patients and professional variables. RESULTS: The mean age was 66.36 years (standard deviation [DE]: 11,56); 48.9% were women. PrI with better compliance were feet examination, glycated hemoglobin and lipid profile (59.6%, 44.3% and 44%, respectively). 2.7% of patients had simultaneous compliance of the six PrI and 11.74% of patients three PrI linkage to incentives. Statistical association was observed in the compliance of the PrI incentives linked or not (P = .001). CONCLUSIONS: The degree of compliance with the PrI for screening chronic complications of T2DM is mostly low but this was higher on indicators linked to incentives

The impact of computer use in myopia progression: a cohort study in Spain.

OBJECTIVE: Many subjects, especially highly educated subjects, are increasingly exposed to computer use. This exposure might represent an explanation for the growing rates of myopia. METHODS: We assessed 17,217 Spanish university graduates from the SUN project, an open-recruitment cohort. Their mean age was 38.5 years (SD 12.1), and their mean time of exposure to computers was 14.3h/week (SD 14.6). We estimated multivariable-adjusted odds ratios (OR) for the risk of myopia development and/or progression (≥0.5 diopters) according to baseline exposure to computer and to changes in exposure. RESULTS: The age and sex-adjusted OR comparing >40 h/week of exposure versus<10h/week was 1.34 (95% confidence interval (CI): 1.12-1.60). This association remained essentially unchanged after additional adjustments. Comparing participants who increased their exposure to computers, versus those with no change, the age and sex-adjusted OR was 1.49 (1.34-1.66). This result was unchanged after additional adjustments. CONCLUSIONS: To our knowledge this is the first large longitudinal assessment in young adults, showing that exposure to computer use is associated with myopia development or progression in a cohort of Spanish university graduates. Further studies are needed to confirm these epidemiological findings.

[Compliance with process indicators in people with type 2 diabetes and linking incentives in Primary Care]. / Cumplimiento de indicadores de proceso en personas con diabetes tipo 2 y la vinculación a incentivos en Atención Primaria.

OBJECTIVE: Pay-for-performance programs to improve the quality of health care are extending gradually, particularly en Primary Health Care. Our aim was to explore the relationship between the degree of compliance with the process indicators (PrI) of type 2 diabetes (T2DM) in Primary Care and linkage to incentives. DESIGN: Cross-sectional, descriptive, observational study. SETTING: Six Primary Health Care centers in Seville Aljarafe District randomly selected and stratified by population size. PARTICIPANTS: From 3.647 adults included in Integrated Healthcare Process of T2DM during 2008, 366 patients were included according sample size calculation by stratified random sampling. MEASUREMENTS: PrI: eye and feet examination, glycated hemoglobin, lipid profile, microalbuminuria and electrocardiogram. Confounding: Age, gender, characteristics town for patients and professional variables. RESULTS: The mean age was 66.36 years (standard deviation [DE]: 11,56); 48.9% were women. PrI with better compliance were feet examination, glycated hemoglobin and lipid profile (59.6%, 44.3% and 44%, respectively). 2.7% of patients had simultaneous compliance of the six PrI and 11.74% of patients three PrI linkage to incentives. Statistical association was observed in the compliance of the PrI incentives linked or not (P=.001). CONCLUSIONS: The degree of compliance with the PrI for screening chronic complications of T2DM is mostly low but this was higher on indicators linked to incentives.

Antral follicle count as a marker of ovarian biological age to reflect the background risk of fetal aneuploidy.

STUDY QUESTION: Can antral follicle count (AFC) measured during pregnancy be used as a marker of ovarian age to assess the background risk of fetal aneuploidy? SUMMARY ANSWER: AFC was lower than expected according to maternal chronological age in trisomic pregnancies; therefore ovarian age could potentially reflect a more precise background risk of fetal aneuploidy screening. WHAT IS KNOWN ALREADY: The decline in a woman's reproductive function is determined by a decline in the ovarian follicle pool and the quality of oocytes. The quantitative status of ovarian reserve can be indirectly assessed by AFC, but the role of AFC as an aneuploidy risk marker in pregnant women has not been assessed yet. STUDY DESIGN, SIZE, DURATION: Our study comprised a prospective cohort including 1239 singleton pregnancies scanned before 14 weeks in our center during a 14-month period. PARTICIPANTS/MATERIALS, SETTING, METHODS: Reference ranges for AFC were constructed using 812 spontaneously conceived, chromosomally normal singleton ongoing pregnancies using the Lambda-Mu-Sigma method. The study population (n = 934) included 19 pregnancies with viable autosomal trisomies (trisomies 21, 18 and 13), 17 non-viable autosomal trisomies (other than 21, 18 or 13), 7 monosomies X, 1 sex trisomy and 3 triploidies (total n = 47 with chromosomal abnormalities). AFC in chromosomally abnormal pregnancies was plotted against the reference ranges. AFC multiple of the median was calculated according to the median AFC obtained by each year of age. MAIN RESULTS AND THE ROLE OF CHANCE: Sixty-eight percent of women carrying a pregnancy with viable trisomies and 65% with non-viable trisomies presented an AFC below the 50th percentile. The median ovarian age in viable trisomies and non-viable trisomies was estimated to be 3 and 6 years above than median maternal age, respectively. However, the median ovarian age in monosomies X and triploidies was not higher than median maternal age. LIMITATIONS, REASONS FOR CAUTION: We did not assess the intra- and inter-observer reliability, or use specific three-dimensional analysis which may have advantages over our two-dimensional study. In clinical practice, a drawback for assessing AFC during pregnancy is that transvaginal ultrasound is needed at the 11- to 13-week scan, when the transabdominal approach is used most commonly. Furthermore identifying ovaries by ultrasound during pregnancy could be challenging. WIDER IMPLICATIONS OF THE FINDINGS: Considering that AFC reflects ovarian aging, this 'ovarian biological age' could potentially reflect a more precise background risk of fetal aneuploidy. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by PI 11/00685. Instituto de Salud Carlos III. Fondo de Investigación Sanitaria. No competing interests declared.

Errores vacunales y situacionesque pueden conducir a erroresen Atención Primaria de salud / Vaccination errors and situations that may lead to mistakes in Primary Care

Objetivo: identificar errores en la administración de vacunas así como situacionesrelacionadas con la similitud de los envases que pudieran dar lugar a errores, enun distrito del Servicio Andaluz de Salud en el año 2007. Los resultados del estudiose utilizaron en una estrategia de difusión, tanto interna como externa.Material y método: estudio descriptivo en el Distrito Sanitario Aljarafe (Sevilla) delServicio Andaluz de Salud (SAS). Se recopiló la información sobre notificacionesde errores en la vacunación durante el año 2007. Se analizaron las similitudesen la denominación y etiquetado entre las vacunas disponibles en los centros.Resultados: se detectaron ocho errores reales por la administración de la vacunaantineumocócica 23-valente en lugar de la vacuna antigripal. Estos errores se debierona la gran similitud en el etiquetado. Se identificaron otros 15 situacionesque pueden conducir a errores relacionadas con el diseño y la denominación. Ladifusión interna se realizó mediante el envío de documentación a los responsablesde la gestión de vacunas en el Área y al Servicio Andaluz de Salud y mediantesesiones informativas para el equipo de Enfermería en los centros. Los errores vacunalesfueron notificados al Instituto para el Uso Seguro de los Medicamentos,que lo comunicó a la Agencia Española de Medicamentos y Productos Sanitariosy a los laboratorios fabricantes de las vacunas implicadas.Conclusiones: las vacunas constituyen un grupo de medicamentos con una alta probabilidadde conducir a errores de administración, relacionados en gran medidacon la similitud en la denominación y el etiquetado. Mientras no se adopten medidaspara diferenciarlas claramente, se requiere el esfuerzo de los profesionalesen la identificación correcta de los cartonajes para evitar errores en la administración (AU)

Objective: to identify errors in the administration of vaccines as well as errors thatcould be a result of similar packaging, in a district of the Andalusian Health Servicein 2007. The results of this study were used in both an internal and externaldissemination strategy.Material and method: descriptive study in the Health District of Aljarafe (Seville)of the Andalusian Health Service (AHS). Information regarding vaccination errorsreported in 2007 was gathered. Similarities in the names and labelling of the differentvaccines available in the centres were analyzed.Results: eight real errors were detected after the administration of the 23-valentantipneumococcic vaccine instead of the flu vaccine. These errors were due to thehighly similar labelling of both types of vaccine. 15 other situations which couldlead to errors related with design and name were identified. Internal disseminationwas carried out via the distribution of documentation to those in charge of vaccinemanagement in the Area and to the Andalusian Health Service and by meansof informative sessions for the Nursing team in these centres. Vaccination errorswere reported to the Institute for the Safe Use of Drugs, which in turn informedthe Spanish Drug and Healthcare Products Agency and laboratories which manufacturedthe vaccines involved.Conclusions: vaccines are a group of drugs presenting a high probability of leadingto administration errors due to their similarities in name and labelling. Untilmeasures are adopted to clearly differentiate them, professionals are required tobe careful in the correct identification of drug packages to avoid administrationerrors (AU)

Los valores en las organizaciones / Values in organizations

El presente artículo tiene como propósito acentuar la importancia del recurso humano en las interacciones que se producen a lo interno de la cultura de las organizaciones, tomando en cuenta el patrón de significados sociológicos, trasmitidos históricamente en el clima laboral, incorporados en símbolos, sistemas de concepciones heredadas, y expresadas en forma simbólica, mediante las cuales el ser humano, trabajador, se comunica con sus compañeros en el ambiente laboral. Dentro de ese patrón de símbolos destacan los valores, que en cuanto a significados específicos, tratan de salvaguardar lo fundamental de la cultura de la organización. Los valores identifican y refuerzan, a través de propuestas socio-culturales coactivas de comportamiento, el compromiso de identificación de funcionamiento, sobrevivencia y logros de los objetivos de una organización.

Cómo mejorar la comunicación de la administración moderna / How to improve the communication of the modern administration

El artículo destaca la importancia de la comunicación en la administración actual, tomando en cuenta tres factores críticos de la comunicación, que casi nunca se destacan cuando se aborda este tema. Estos factores son el rol, el estatus y la forma de escuchar. El artículo analiza en forma rápida los roles de la comunicación, cómo se presentan, cómo se transmiten y la importancia de ellos de acuerdo con las diferentes posiciones de las personas en la organización, y cómo juegan un papel fundamental a la hora de comunicarse los funcionarios. El estatus que va muy paralelo al rol, es un factor fundamental para comprender cómo la comunicación puede mejorarse o, por el contrario, perjudicarse de acuerdo con el estatus que cada funcionario tenga y la importancia que le dé cada persona. La forma de escuchar es fundamental para comunicarse y sobre todo para mejorar la comunicación en la administración actual; no se sabe escuchar y de ahí la mala comunicación que impera en casi todas las órdenes de la organización, por lo que se hace énfasis en el artículo en cómo las personas deben aprender a escuchar para que la comunicación pueda fluir con facilidad

La administración del recurso humano para la salud / Human Resource in health administration

El artículo destaca la importancia del concepto administración de recursos humanos, en el sentido de un proceso secuencial de alcanzar la potencialidad del ser humano hacia los objetivos institucionales, reconociendo las necesidades y las expectativas de los individuos que conforman las organizaciones. Luego de un análisis de las principales variables de la administración de recursos humanos, concluye con la importancia de formar cuadros profesionales, cuya labor principal se centra en funciones de prevención de la salud y por ende muy relacionadas con las necesidades de la población en la cual se destacan. Las líneas de acción que propone el autor, van a encontrar bloqueos y medidas restrictivas por parte de la clase hegemónica y su estado